Supporting a fair approach to COVID triage

A limited supply of life-saving medical equipment in the NHS is raising important questions about how frontline clinicians prioritise coronavirus patients for use of scarce resources and Essex rights experts are providing critical support to help avoid discrimination.

A team of researchers linked to the Essex Autonomy and Ethics of Powerlessness Projects have provided a vital overview of existing guidelines around the world, subjecting them to a bioethical and human rights analysis.

Their work aims to help NHS ethics committees formulate fair policy and triage procedures for coping with the extraordinary pressures of the pandemic.

Published this week, their report addresses the limitation of the well-known triage principle of maximising the number of lives saved on the basis of a clinical assessment of prognosis.

In order to help clinicians potentially faced with the agonising choice of whose lives should be saved, the team have explored how guidelines address issues such as whether an age limit should be set in order to triage patients or whether randomisation is a fair approach.

“Our aim has been to provide a survey of existing research and guidance in a form useful to policymakers who are struggling to formulate just and evidence-based principles of triage during the COVID-19 pandemic,” explained Professor Sabine Michalowski, from the School of Law, who is leading the project.

“Because there are no easy answers or uncontroversial approaches to many of the pressing issues arising in triage, it is crucial to have clear criteria in place on which decisions are based, as well as procedures that will be followed as part of the decision-making process.”

Professor Michalowski explained that human rights must not be forgotten in developing responses to the medical and economic crises.

“It is important for policymakers to be aware that, although there may not be one ‘right answer’ to the question about triage management, there are clearly some ‘wrong answers’ and it’s important to design and apply criteria with acute awareness of the importance of avoiding discrimination, based on age or disability for example.”

Described by one frontline professional as “extremely useful as an incredibly clear synthesis of the literature and issues”, the report will also form the basis for a lecture on the ethics of triage by Professor Wayne Martin of the School of Philosophy and Art History.

Find out more about how the Essex Autonomy Project is helping frontline care staff.